Department of Paediatrics and Child Health

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Browsing Department of Paediatrics and Child Health by browse.metadata.advisor "Bekker, Adrie"

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    Burden, spectrum and outcome of community-acquired infections among paediatric ward admissions to Tygerberg Hospital
    (Stellenbosch : Stellenbosch University, 2020-12) Mapala, Lydia; Bekker, Adrie; Dramowski, Angela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Introduction: Community acquired infections (CAIs), both bacterial and viral in origin, are the most common reason for hospitalization in general paediatric wards. Data from South Africa on the burden, pathogen spectrum, antimicrobial therapy and outcome of paediatric CAIs is limited. Methods: We conducted secondary analysis of data from a prospective cohort of consecutive paediatric admissions to a general ward at Tygerberg Hospital (May - November 2015). Demographics, admission history, laboratory investigations, antimicrobial prescription and hospital outcome data were collected. Results: Of 451 admissions, 364 (81%) were for CAI episodes. Median age and weight of patients with CAI was 4.8 months (IQR 1.5-17.5) and 5.4 kg (IQR 3.6-9.0) respectively. Male gender predominated (210/364; 58%), and HIV-infection prevalence was 6.0% (22/364). Sources of referral were: home (139/364, 38%), other hospitals (113/364, 31%) and clinics (112/364, 31%). Pre-hospital antibiotics (commonly ceftriaxone) were given to 152/364 (42%) of patients. The most prevalent CAI types (n=364) were: respiratory tract infections (197; 54%), gastroenteritis (51; 14%), bloodstream/serious bacterial infections (33; 9%), meningitis (17; 5%) and urinary tract infections (8; 2%). Of 274 blood cultures submitted, 5% yielded a pathogen and 8% were contaminated. Of 140 cerebrospinal fluid samples sent, only 2% yielded a pathogen. Of investigations for respiratory infection, respiratory syncytial virus (RSV), adenovirus (AV) and parainfluenza virus predominated from shell vial culture, whereas RSV, cytomegalovirus and rhinovirus were most frequently identified on polymerase chain reaction testing. Most frequent CAI antibiotic treatment regimens included: ampicillin alone (53%); ampicillin plus gentamicin (25%) and ampicillin plus cefotaxime (20%). Unfavourable outcomes were uncommon (1% died; 4% required re-admission within 30 days of discharge). The majority of antibiotic prescriptions for CAI (323/364; 89%) were compliant with the Essential Drug List (EDL) guidelines. The overall estimated cost of CAI episode management was R 8.2 million or R22,527 per CAI admission episode. Conclusion: CAI's are the most frequent reason for hospitalization and a major driver of antimicrobial use and hospital costs in general paediatric wards. Improved diagnostic stewardship should be implemented in South African paediatric wards to reduce culture contamination, improve pathogen yield, minimize use of unnecessary investigations and reduce inappropriate antimicrobial prescriptions. Despite a high burden and hospital cost of CAI admissions, paediatric clinical outcomes were generally favourable.
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    Central line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit
    (Stellenbosch : Stellenbosch University, 2016-12) Geldenhuys, Chandre; Bekker, Adrie; Dramowski, Angela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH SUMMARY: Background: The rate of central line-associated bloodstream infection (CLABSI) in South African public sector neonatal intensive care units (NICU) is unknown. Tygerberg Children’s Hospital (TCH) introduced a neonatal CLABSI surveillance and prevention programme in August 2012. Objectives: To describe CLABSI events and identify risk factors for development of CLABSI in a resource-limited NICU. Methods: A retrospective case-control study was conducted using prospectively collected NICU CLABSI events matched to four randomly selected controls, sampled from the NICU registry between 9 August 2012 and 31 July 2014. Clinical data and laboratory records were reviewed to identify possible risk factors using stepwise forward logistic regression analysis. Results: Seven hundred and six central lines were inserted in 530 neonates during the first two years of the programme. Nineteen CLABSI events were identified with a CLABSI rate of 5.9/1000 line days. CLABSI cases were of lower gestational age (28 vs 34 weeks; p=0.003), lower median birth weight (1170g vs 1975g; p=0.014), had longer catheter dwell times (> 4 days) (OR 5.1 [95% CI 1.0-25.4]; p=0.04) and were more likely to have surgery during their NICU stay (OR 3.5 [95% CI 1.26-10]; p=0.01). Significant risk factors for CLABSI were length of stay > 30 days (OR 20.7 [95% CI 2.1-203.2]; p=0.009) and central line insertion in the operating theatre (OR 8.1; [95% CI 1.2-54.7]; p=0.03). Gram-negative pathogens predominated (12/22; 54%), with most isolates 10/12 (83%) exhibiting multi-drug resistance. Conclusion: The TCH NICU CLABSI rate is similar to that reported from resource-limited settings but far exceeds that of high-income countries. Prolonged NICU stay and central line insertion in the operating theatre were important risk factors for CLABSI development. Intensified neonatal staff training regarding CLABSI maintenance bundle elements and hand hygiene is key to reducing CLABSI rates.
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    Clinical presentation and treatment outcomes of infants with tuberculosis in Cape Town, South Africa
    (Stellenbosch : Stellenbosch University, 2020-12) Aryao, Ruth; Bekker, Adrie; Dramowski, Angela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Introduction: Limited data are available regarding the presentation, clinical course and outcome of infants (<12 months of age) treated for drug-susceptible tuberculosis. Methods: Infants with tuberculosis admitted at Tygerberg, Khayelitsha District and Brooklyn Chest Hospitals (March 2014-March 2015) were prospectively enrolled with follow-up evaluations at 3- and 6-months post-treatment initiation. Results: Among 39 infants diagnosed with tuberculosis, 21 (54%) had known contact with an adult tuberculosis source case. The median age of infants at diagnosis was 6 months (IQR 3-7) and median weight 5.2 kg (IQR 3.2–10.2). Twenty-two of 39 (56%) were exposed to HIV of whom 5 were HIV infected. Growth faltering (25; 68%) and persistent cough (13; 33%) were frequent presenting symptoms. Most infants were diagnosed with intrathoracic tuberculosis (37/39; 95%) while 5% had disseminated tuberculosis and (14/39; 36%) had culture-confirmed tuberculosis. Alveolar opacification (22; 56%), mediastinal lymphadenopathy (13; 33%) and large airway obstruction (8; 20%) were common chest radiography findings. Tuberculosis treatment outcomes were favourable in 33/39 (85%) infants, but with additional intervention 37 (95%) completed treatment. Conclusions: Intrathoracic tuberculosis was the predominant disease type and one-third of the cohort had culture-confirmed tuberculosis. More than half on the infants were born to a mother with HIV. An adult tuberculosis source case was identifiable in half of the cases. Additional interventions improved favourable treatment outcomes.